Document Detail


Measuring the Impact of Multidisciplinary Care on Quality for Pancreatic Surgery: Transition to a Focused, Very High-volume Program.
MedLine Citation:
PMID:  23896243     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Outcomes are superior for pancreatic resection at high-volume centers. To assess the impact of focused high-volume multidisciplinary care, a quality index (QI) was used to review our experience. Data from 1996 to July 2012 were analyzed in three groups: 1) early (1996 to 2007); 2) transition (2008 to 2009); and 3) mature (2010 to July 2012). A total of 239 patients were included with a mean age of 63.4 years and the majority were white (65.7%). The number of patients with Charlson comorbidity index greater than 2 and age older than 80 years increased comparing Group 1 with latter groups. Volume increased over time: Group 1 (n = 93) 7.75/year, Group 2 (n = 51) 25.5/year, and Group 3 (n = 95) 39/year. Overall mortality was 5.9 per cent: Group 1, 4.3 per cent; Group 2, 11.5 per cent; and Group 3, 3.9 per cent (P = 0.0454). The QI score incorporates documentation, chemotherapy, resection for Stage I/II, time to treatment, margins, lymph nodes, mortality, and surgical volume with a maximum possible score 10. The QI increased over time: 3 in Group 1; 4 in Group 2; and 6 in Group 3. An improvement was noted for the quality indicators: surgical resection (P = 0.0125) and use of palliative and adjuvant therapy (P = 0.0144 and < 0.0001). Implementation of a focused multidisciplinary pancreatic surgery program increases quality.
Authors:
Timothy L Fitzgerald; Noah M Seymore; Swapnil D Kachare; Emmanuel E Zervos; Jan H Wong
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American surgeon     Volume:  79     ISSN:  1555-9823     ISO Abbreviation:  Am Surg     Publication Date:  2013 Aug 
Date Detail:
Created Date:  2013-07-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370522     Medline TA:  Am Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  775-80     Citation Subset:  IM    
Affiliation:
Division of Surgical Oncology, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA.
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